Clinical

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Pacing in syncope for select patients only

The 2017 ACC/AHA/HRD guideline for syncope evaluation and management concludes that the evidence does not yet support the use of pacing for reflex-mediated except among those with both recurrent vasovagal syncope and asystole documented by implantable loop recorder.

Citation: Varosy P et al. Pacing as a treatment for reflex-mediated (vasovagal, situational, or carotid sinus hypersensitivity) syncope: A systematic review for the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope. J Am Coll Cardiol. 2017 Aug 1;20(5):664-79.

Postoperative opioids often underutilized

Between 67% and 92% of patients report postoperative opioid oversupply, defined as filled but unused opioid prescriptions or unfilled opioid prescriptions. Half of the filled prescriptions were unused, with the majority reporting that the narcotics were not stored in locked containers.

Citation: Bicket MC et al. Prescription opioid analgesics commonly unused after surgery: A systematic review. JAMA Surg. 2017 Aug 2. doi: 10.1001/jamasurg.2017.0831

5-hour protocol for contrast allergy safe and effective

Observational study showing a 5-hour IV steroid protocol was noninferior to a traditional 13-hour oral premedication regimen in patients at high risk for IV contrast reactions.

Citation: Mervak BM et al. Intravenous corticosteroid premedication administered 5 hours before CT, compared with a traditional 13-hour oral regimen. Radiology. 2017 Nov;285(2):425-33.

Poor food intake and chills predict true bacteremia in hospitalized patients

Observational study showing that poor food consumption had a sensitivity of 93.7% and shaking chills a specificity of 95.1% in diagnosing true bacteremia based on blood culture results.

Citation: Komatsu T et al. A simple algorithm for predicting bacteremia using food consumption and shaking chills: a prospective observational study. J Hosp Med. 2017 Jul;12(7),510-5.

Lower readmission rates do not lead to increased postdischarge mortality at 30 days

Post–Affordable Care Act reductions in 30-day hospital risk-adjusted readmission rates for heart failure, acute MI, and pneumonia among Medicare beneficiaries did not increase but were weakly associated with decreased 30-day post–hospital discharge risk-adjusted mortality.

Citation: Dharmarajan K et al. Association of changing hospital readmission rates with mortality rates after hospital discharge. JAMA. 2017Jul 18;318(3):270-8.

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